Laboratory Control, Optimal Therapeutic Ranges and Therapeutic Quality Control in Oral Anticoagulation

Ea, Loeliger

doi:10.1159/000206187

Cited by 44 publications

(25 citation statements)

References 21 publications

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“…for surgery); or (b) the interval between consecutive INR measurements exceeded 60 days (i.e., the extrapolation being considered too inaccurate in this case). We also calculated the time in therapeutic range using a crosssectional analysis [18,19], to confirm the results obtained with the linear interpolation model. Secondary outcomes variables were the number of hemorrhagic complications and thromboembolic events.…”

Section: Discussionmentioning

confidence: 59%

Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation

O’Shea

Arcasoy

Samsa

et al. 2007

J Thromb Thrombolysis

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Section: Discussionmentioning

confidence: 59%

Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation

O’Shea

Arcasoy

Samsa

et al. 2007

J Thromb Thrombolysis

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“…In literature, several methods to assess therapeutic control are described: e.g. the assessment of the number of INR measurements within the target range expressed as a percentage of the total number of INRs obtained, the cross-section-of the-files technique (the fraction of patients in range at one point in time compared to the total number of patients who had an INR at that point in time), equidivision, linear interpolation and the hybrid method [52], [56], [57]. Each approach has its advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

Benchmark for Time in Therapeutic Range in Venous Thromboembolism: A Systematic Review and Meta-Analysis

et al. 2012

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IntroductionThe percentage of time within the target INR range 2.0 to 3.0 (TTR) in patients treated with vitamin K antagonists varies considerably among efficacy-studies of novel anticoagulants. In order to properly asses the quality of anticoagulant control in upcoming cost-effectiveness studies and real life registries this systematic review reports a benchmark of TTR for different treatment durations in patients with venous thromboembolism and discusses ways to calculate TTR.MethodsMedline and Embase were searched for studies published between January 1990 and May 2012. Randomized controlled trials and cohort studies reporting the TTR in patients with objectively confirmed venous thromboembolism treated with vitamin K antagonists (VKA) were eligible. Duplicate reports, studies only reporting INR during initial treatment or with VKA treatment less than 3 months were excluded. Three authors assessed trials for inclusion and extracted data independently. Discrepancies were resolved by discussion between the reviewers. A meta-analysis was performed by calculating a weighted mean, based on the number of participants in each included study, for each time-period in which the TTR was measured since the confirmation of the diagnosis of VTE.ResultsForty studies were included (26064 patients). The weighted means of TTR were 54.0% in the first month since the start of treatment, 55.6% in months 1 to 3, 60.0% in months 2 to 3, 60.0% in the months1 to 6+ and 75.2% in months 4 to 12+. Five studies reported TTR in classes. The INR in these studies was ≥67% of time in therapeutic range in 72.0% of the patients.ConclusionReported quality of VKA treatment is highly dependent on the time-period since the start of treatment, with TTR ranging from approximately 56% in studies including the 1st month to 75% in studies excluding the first 3 months.

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“…The cross-section-of-the-files method [5] is calculated by picking a date of interest and reviewing only the last INR (one INR per patient) on all patients in the clinic and determining the percent of INRs in range. An advantage to this method is its usefulness to estimate the time in range for a group of patients managed outside of a computerized anticoagulation system.…”

Section: Calculation Of the Time In Therapeutic Rangementioning

confidence: 99%

Determinants and measures of quality in oral anticoagulation therapy

Kaatz

2007

J Thromb Thrombolysis

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Using clinical trial bleeding and thromboembolic complication rates to set quality measurement targets for anticoagulation clinics may not be appropriate, given the inherent difference in these patient populations. Additionally, there are pragmatic issues affecting the completeness and accuracy of adverse event gathering outside of a trial scenario that could be misleading. The time in the therapeutic range, however, is relatively easy to calculate and is a well substantiated surrogate marker for complication rates and should be a standard quality indicator. Benchmark targets for time in range are dependent on the methodology used in the calculation and should be adjusted accordingly.

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Laboratory Control, Optimal Therapeutic Ranges and Therapeutic Quality Control in Oral Anticoagulation

Cited by 44 publications

References 21 publications

Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation

Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation

Benchmark for Time in Therapeutic Range in Venous Thromboembolism: A Systematic Review and Meta-Analysis

Determinants and measures of quality in oral anticoagulation therapy

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